A total of approximately 80 patients with each of three specific diagnoses and 40 participants with an overlap disorder have been seen in the NIH Clinical Center. Natural history data have been collected on all 280 participants, including ophthalmologic, otolaryngologic, echocardiography and rehabilitation medicine consultations. Our studies have documented newly recognized gastrointestinal complications of these disorders, and that chronic musculoskeletal pain is a significant complication of both EDS and Stickler syndrome. Echocardiography analysis of patients with Ehlers-Danlos syndrome demonstrated a 30% incidence of aortic root dilation in this group of patients. We have compared the Berlin and Gent nosologies for the Marfan syndrome in our population and examined the efficacy of screening for dural ectasia in the diagnosis of the Marfan syndrome. We have analyzed the prevalence of spinal and hip abnormlities in Stickler syndrome and their relationship to chronic pain. Our studies documented an increased risk of femoral head failure in children with Stickler syndrome. We have developed proposed diagnostic criteria for Stickler syndrome based on our clinical and molecular studies in this population. We have identified a previously undescribed connective tissue disorder with features resembling Marfan syndrome, Stickler syndrome and the Ehlers-Danlos syndrome. Chronic musculoskeletal pain is a serious complication of many of the hereditary disorders of connective tissue. We have performed a pilot study of the Mindfulness-Based Stress Reduction program to examine its efficacy in the relief of chronic pain in this population. We plan to pursue the mechanism of chronic musculoskeletal pain in this population and continue to explore alternative means of ameliorating the pain. Two manuscripts are currently in preparation as a result of work done under this project. They are: (1) Liberfarb RM, Rose PS, Levy HP, Davis J, Balog JZ, Szymko YM, Wilkin DJ, Johnston J, Francomano CA. Phenotype/genotype correlatiosn in 10 families with Stickler syndrome resulting from 7 mutations in the type II collagen gene locus COL2A1. (submitted to Genetics in Medicine; under revision). (2) Rose PS, Levy HP, Davis J, Johnston J, Szymko Y, Rubin B, Tsilou E, Kaiser M, Griffith AJ, Liberfarb RM, Francomano CA. The Stickler Syndrome: Clinical characteristics and diagnostic criteria. In preparation.